Allogeneic Umbilical Cord-Blood-Derived Mesenchymal Stem Cells and Hyaluronate Composite Combined with High Tibial Osteotomy for Medial Knee Osteoarthritis with Full-Thickness Cartilage Defects

Abstract

Background and Objectives: Although the effects of cartilage repair in patients who are undergoing high tibial osteotomy (HTO) remains controversial, cartilage repair may be required for the full-thickness cartilage defect because of a concern of lower clinical outcome. The purpose of this study was to investigate clinical outcome and cartilage repair following implantation of allogeneic umbilical cord-blood-derived MSCs (UCB-MSCs)-hyaluronate composite in patients who received HTO for medial knee osteoarthritis (OA) with full-thickness cartilage defect. Materials and Methods: Inclusion criteria were patients with a medial knee OA, a full-thickness cartilage defect (International Cartilage Repair Society (ICRS) grade IV) ≥ 3 cm2 of the medial femoral condyle, and a varus deformity ≥ 5°. The full-thickness cartilage defect was treated with implantation of an allogeneic UCB-MSCs-hyaluronate composite following medial open-wedge HTO. Visual analogue scale for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were assessed at each follow-up. Cartilage repair was assessed by the ICRS cartilage repair assessment system at second-look arthroscopy when the plate was removed. Results: Twelve patients (mean age 56.1 years; mean defect size: 4.5 cm2) were included, and 10 patients underwent second-look arthroscopy during plate removal after a minimum of 1 year after the HTO. At the final follow-up of mean 2.9 years (range; 1–6 years), all clinical outcomes had improved. At second-look arthroscopy, repaired tissue was observed in all cases. One case (10%) showed grade I, seven (70%) cases showed grade II, and two (20%) cases showed grade III according to ICRS cartilage repair assessment system, which meant that 80% showed an overall repair assessment of “normal” or “nearly normal”. Conclusion: Allogeneic UCB-MSCs-HA composite implantation combined with HTO resulted in favorable clinical outcome and cartilage repair in all cases. These findings suggest that UCB-MSCs-HA composite implantation combined with HTO would be a good therapeutic option for patients with knee OA and full-thickness cartilage defects.

Implantation of hUCB‐MSCs generates greater hyaline‐type cartilage than microdrilling combined with high tibial osteotomy

“…The proportion of patients with one or more improvements in ICRS grades at second-look arthroscopy (primary outcome measure) was significantly higher in the hUCB-MSC implanted group, providing further support for its efficacy. Several studies have also found that the outcomes of hUCB-MSC implantation were favourable when combined with HTO [18,22,34,44,45]. Despite the short follow-up in the present study, the mean IKDC score was comparable to those of previous studies (59.…”

“…The indication for this treatment corresponds, to some extent, to that of HTO. Accordingly, hUCB-MSC implantation combined with HTO is being considered, demonstrating promising results [22,34,44,45].…”

“…However, the potential for long-term deterioration and future conversion to total knee arthroplasty persists [10]. Hence, efforts are underway to improve long-term outcomes and prolong survival after HTO by incorporating supplementary cartilage procedures [18,22,23,34,45].…”

Postoperative management following osteotomies around the knee: a narrative review

“…MSC injections may have positive benefits for the treatment outcome and therefore further randomized controlled trials (RCTs) are necessary. Two additional studies on MSC injections were published after publication of the systematic review of Jin et al They show favorable trends for cartilage cell regeneration, but its generalizability is limited due to small sample sizes ( n = 20 ( 15 ) and n = 12 ( 16 )).…”

Therapeutic effects of different intervention forms of human umbilical cord mesenchymal stem cells in the treatment of osteoarthritis

“…The results showed that good clinical efficacy and cartilage repair was achieved in all cases with allogeneic hUCB-MSC-HA composite implantation combined with HTO. These findings suggest that for patients with knee OA and full thickness cartilage defects, hUCB-MSC-HA composite implantation combined with HTO may be a promising treatment options ( Park et al, 2023 ).…”